Monday, November 14, 2016

Application Overload

The Emergency Medicine match feels more competitive than ever before.  This perception is NOT supported by the best available data from the NRMP.  

The Numbers

There has been a steady increase in the number of applicants to EM each year, mostly driven by an increase in the number of allopathic graduating seniors (see Table 1 below). The number of "non-traditional applicants" (including osteopathic and international graduates) has actually leveled off.  

At the same time, opportunities to train in EM have increased. The number of PG1 positions available in the EM match has steadily gone up (blue line in Table 1).  This increase comes from both new programs opening and class expansion in existing EM programs. The result is that the ratio of available training spots to the number of applicants has not significantly changed. The ratio of available spots to those who want them is the same.  

Table 1 - Proportional increase in both number of applicants and number of training positions in Emergency Medicine.

What has changed is the number of programs that each student applies to (see Table 2).  For many years the average number was approximately 25 programs applied to per student.  Starting in 2010 there has been a dramatic increase from year to year in the number of programs applied to by each applicant. The trend is similar among "non-traditional" applicants.  

Table 2 - Increase in programs applied to per allopathic applicant in the match.  

The Consequences

Each residency program is receiving dramatically more applications. This has made the competition greater for their interview offers. Not for the actual interviews, because the relative number of applicants has not changed - just for the interview offer.

Programs have had to change how they review applications and choose who to offer interviews to. Faculty time is a finite resource at most programs. There may not have been more time available to dedicate to in-depth application review. Furthermore, the time period to review applications was compressed in 2013 when the MSPE release date moved up to October 1st.

Programs had little choice but to become more efficient at reviewing applicants. Options include only reviewing parts of the application, those portions felt to be more objective or higher yield (the SLOE's). Another option is to make greater use of the filters ERAS provides, such as setting a cut-off for step 1 scores.  Additionally, programs can give more attention to applicants from schools or regions that have been high yield in the past.  
With this increase in efficiency comes a loss of variability in applicant review. The same group of applicants will appear strong to most programs. These applicants will then receive the majority of the interview offers. This fortunate group of applicants will need to reject interview offers before they "trickle down" to the rest of the pool.

Some of the fortunate will choose to do more than the 12 interviews they need to be >95% assured of matching. Even so, most programs have responded to the overload of applications by interviewing greater numbers of applicants in the hopes of not missing anyone they want to meet.

In Summary

  1. The perception that EM is getting more competitive is not real
  2. There is greater competition for early interview offers
  3. Interview offers are concentrated in a fortunate few
  4. Interview opportunities will "trickle down" to most applicants
  5. For advice on how to get those interviews check out the FAQ section on this post on Acing the Interview

Adam Kellogg is an Associate Residency Director and a former Clerkship Director. He is a past Chair of the CORD Student Advising Task Force, whose mission is to improve the quality of the advising students receive who are applying to Emergency Medicine.